A new study from the Agency for Healthcare Research and Quality highlights the problem of inappropriate prescribing for elderly patients in the United States. The study also underscores the importance of safe use of prescription medications as a critical component of quality of care and demonstrates the challenges involved in assessing safe use.
According to findings reported in the Journal of the American Medical Association, about one-fifth of the approximately 32 million elderly Americans not living in nursing homes in 1996 used at least 1 of 33 prescription medicines considered potentially inappropriate. Nearly 1 million elderly men and women used at least 1 of 11 medicines that a panel of geriatric medicine and pharmacy experts advising the researchers agreed should always be avoided in the elderly. These 11 medicines include long-acting benzodiazepines, sedative or hypnotic agents, long-acting oral hypoglycemics, analgesics, antiemetics, and gastrointestinal antispasmodics.
The study also suggests that elderly women and older people who are in poor health and consequently use more prescriptions are more likely than others to receive inappropriate drugs. According to lead author, Chunliu Zhan, M.D., Ph.D., the actual extent of inappropriate medication prescribing may be much higher than the estimates because of the conservative criteria the researchers used and because of the rate of introduction of new pharmaceutical agents into the market. Furthermore, inappropriate medication use in the elderly is a component of the even larger problem of suboptimal prescribing, which includes underuse of effective medications, inappropriate dosing, inappropriate use of drugs in combination, and other prescribing errors.
The full list of 33 potentially inappropriate medications reflects the consensus of the expert panel. Not all physicians agree about the appropriateness of specific drugs for the elderly. This lack of consensus stems in part from the limited amount of evidence on risks and benefits for some medications because older patients often are excluded from drug clinical trials due to their age and other medical problems.
The estimates are the most recent derived from population-based nationally representative survey data. The study was based on data from AHRQ's Medical Expenditure Panel Survey (MEPS) involving a national sample of 2,455 community-dwelling people aged 65 and older in 1996.For further details, see "Potentially inappropriate medication use in the community-dwelling elderly: Findings from the 1996 Medical Expenditure Panel Survey," by Dr. Zhan, Judith Sangl, Sc.D., Arlene S. Bierman, M.D., M.Sc., and others in the December 12, 2001 Journal of the American Medical Association 286(22), pp. 2823-2829.
Reprints (AHRQ Publication No. 02-R030) are available from the AHRQ Publications Clearinghouse and AHRQ InstantFax.
Editor's Note: AHRQ and the Department of Health and Human Services (HHS) are supporting research and other efforts to reduce inappropriate prescribing. For instance, AHRQ is sponsoring research on new technologies, such as hand-held computers, to reduce prescribing errors as part of its $50 million patient safety research agenda. In addition, AHRQ-supported Centers for Education and Research on Therapeutics (CERTs) are working to increase awareness of the benefits and risks of new uses or combinations of medical products, as well as improving the effectiveness of existing uses. In March 2001, HHS Secretary Tommy G. Thompson created an HHS Patient Safety Task Force to better coordinate efforts to collect and report information about patient safety.